Spinal stenosis affects millions of Americans causing pain and limited ability to walk. With aging, spinal stenosis commonly occurs due to arthritis in the spine. Here is an overview.
The spine is composed of a column of vertebrae interposed with intervertebral discs. The spinal cord is enclosed and protected by the bony elements of the spine. Over time, these structures are prone to degenerative change.
This is the result of cumulative compressive, rotational and shearing forces related to repetitive bending, lifting and the simple wear and tear of aging. Spinal stenosis, very simply, is prominent arthritis of the spine.
Causes of Spinal Stenosis
The intervertebral discs undergo dehydration and loss of height with aging. As a result, the vertebrae themselves are drawn closer together producing increased loading forces across the facet joints. The facet joints are where the vertebrae articulate with each other via true synovial joints.
Much like any other true joint in the body, they are prone to arthritic change. Arthritis progresses from minor damage to the cartilage lining to bony “spurring” of the adjacent bone. As bone attempts to heal itself, it tends to form new bone. This overgrowth of bone results in “spurs.” This phenomenon can also occur at the edges of the vertebrae themselves. Additional degenerative change of the ligaments of the spine results in thickening and stiffening of these structures.
When all of these degenerative changes are very prominent in the spine, they can cause concentric narrowing of the spinal canal and actually compress the spinal cord. This occurs in the cervical spine (neck area). When spinal stenosis affects the low back or lumbar spine, compression can occur of the tail end of the spinal cord (the conus medullaris) or of the bundle of lumbar and sacral nerves as they exit the spinal cord.
This bundle of nerves is called the cauda equina. Arthritis can also lead to narrowing of the foramina which are the openings through which the spinal nerves exit the spinal canal.
Signs and symptoms of Spinal Stenosis
Stenosis is most common in the cervical and lumbar regions. Severe cervical spinal stenosis can lead to compression of the cervical spinal cord. This is a dangerous situation which can progress to weakness of all the limbs and bowel and bladder disturbances. Less severe cervical stenosis can cause a painful stiff neck with or without irritation of the cervical spinal nerves (cervical radiculopathy or “pinched nerves”) which can present with arm, shoulder or upper back pain, arm weakness and/or numbness.
Similarly, lumbar stenosis causes low back pain with or without signs of nerve root irritation. Patients typically report relief of symptoms with flexion (forward bending) of the lumbar spine and worsening with extension (backward bending of the spine).
Treatment of Spinal Stenosis
Conservative treatment consists of non-steroidal anti-inflammatory medications, physical therapy and epidural steroid injections. Patients may benefit from activity modifications. Instead of walking upright, bending forward over a walker or shopping cart may be better tolerated.
Stationary biking while leaning over the handlebars is a useful form of exercise for persons with lumbar stenosis. Use of a recliner instead of a straight-back chair may also relieve lower back pain due to lumbar stenosis.
Medication management may be very effective for easing the pain of spinal stenosis which may include NSAIDS, muscle relaxers, neuropathic medications or short term narcotics.
Complete Care Medical Center offers Fort Lauderdale pain management services on a self pay basis with several Board Certified pain doctors. Patients are seen from a broad area throughout South Florida and appointments are readily available.
Call (954) 271-2327 for more information and scheduling today!